Preventing rickets: sunlight exposure may not be sufficient

▸ Several factors have prompted the American Academy of Pediatrics (AAP) to reconsider its recommendations regarding vitamin D intake. The number of breast-fed infants is increasing, new evidence suggests that early sun exposure is a risk factor for the development of skin cancer, and the National Academy of Sciences recently reduced the amount of daily vitamin D considered necessary for prevention of rickets (from 400 IU/day to 200 IU/day). Highlights of the new recommendations include:

All breast-fed infants who take less than 500 mL/day of vitamin D-fortified formula should receive 200 IU/day of vitamin D within the first 2 months of life. (All formulas in the U.S. contain at least 400 IU/L, and multivitamins usually contain 400 IU/mL.) All non-breast-fed infants who take less than 500 mL/day of vitamin D-fortified formula should receive multivitamins with vitamin D. This recommendation should affect very few healthy formula-fed infants, as most consume more than 500 mL/day of formula.

Comment

▸ Although the AAP calls these recommendations “guidelines”, it does not present the strength of evidence that should underlie such statements. It also acknowledges that there are limited data to support its recommendations. However, given the low cost and ease of providing multivitamins to infants, the suggestions represent a reasonable approach to the problem of rickets and low vitamin D intake. It is likely that some parents of breast-fed infants will object to giving their children multivitamins; in such cases, ensuring adequate, safe exposure to sunlight is important.

Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 14, 2003.

The evolving science of peanut allergy

▸ The apparent increase in cases of peanut allergy has led to renewed study of the allergy’s etiology and treatment. …